Fever in our First Nations

In a CMAJ practice article, Bagnall and colleagues describe acute rheumatic fever in a member of Canada’s immigrant population.1 The same article correctly identifies Canada’s First Nations as a population at risk for this disease. Social determinants of health are contributory: poverty, inadequate housing and systemic neglect. The Sioux Lookout Acute Rheumatic Working Group recently identified eight cases of acute rheumatic fever in First Nations youth, including two young children for whom the disease was fatal.

We are at a crossroads in how we perceive and respond to the inequities present for First Nations communities in Canada. Deaths from acute rheumatic fever are preventable. Inadequate housing and overcrowding play a direct role in the incidence of acute rheumatic fever, a disease unheard of in the rest of Canada.

The social and health care needs of First Nations are apparent to the Truth and Reconciliation Commission of Canada,2 the United Nations,3 the Auditor General4 and the Senate.5 We suggest it is also of keen interest to Canadian physicians and their patients, who may be experiencing vast health and social inequities first hand.